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Women may be getting worse treatment for heart attack than men

Feb 23/2012. Women are less likely than men to exeperience chest pain as a first symptom of heart attack. This may delay correct diagnosis. The risk of early death is higher in women compared to similarly aged men. These are the results of a recently published study that analyzed more than one million hospital admissions in the United States between 1994 - 2006 and was published yesterday in the Journal of the American Medical Association (JAMA), the original scientific paper can be found here. The study was based on data from the NRMI (National Registry for Myocardial Infarction).

About 42 percent of women didn't have chest pain when they were admitted to the hospital compared with about 31 percent of the men. Overall, about 15 percent of the women died in the hospital, compared with 10 percent of men. The researchers point out that it may be more difficult to diagnose heart attack if the patient does not have chest pain. This fact makes it more likely that diagnosis will be delayed among the women than among the men. The study also found that women are not as likely to get immediate treatment with things like clot-busting drugs and balloons that open arteries, which can stop a heart attack in progress.

Individuals without chest pain, women and men, came into hospital for treatment on average about two hours later than those who had chest pain and EKGs to check for signs of heart attack were taken about 15 minutes later than among those with chest pain. These patients were less likely to receive acute therapies aimed at restoring coronary blood flow and were significantly less likely to receive these lifesaving therapies in a timely manner compared with patients who had chest pain on admission.

Lead author Dr John Canto (Lakeland Regional Medical Center, FL) commented: "While chest pain is still the hallmark symptom of MI (heart attack) in women, more women than men present without chest pain, and this is particularly applicable to younger women. We need to be more aware that younger women with atypical symptoms could be having a MI."

The second major finding of the study was that younger women having an MI have a higher risk of death. "Younger women are not supposed to have an MI, but when do, they are at higher risk of death than the rest of the population," Canto commented.

Canto also suggested that the higher likelihood of atypical symptoms in younger women could contribute toward their high death rate. "If a young women presents without chest pain, it is easy not to realize that she is having an MI. Triage staff are less likely to think about MI in a younger woman, especially one without chest pain, so there is a higher probability of not receiving timely treatment. This could easily explain some of the increased mortality in this group."

He added: "Our results challenge the wisdom that one size fits all in terms of men and women and presenting MI symptoms. I would argue that we need to tailor the MI message and that young women are particularly at risk for an atypical presentation." Canto noted that the atypical symptoms of MI include pain in the jaw, neck, shoulder, arm, back, or stomach and unexplained shortness of breath.

Cardiologist Cam Pattersson at North Carolina University Chapel-Hill says, "When I ask my wife what is she most afraid of, she says breast cancer. And yet she is six times more likely to die of a heart attack. We have a desperate message to share about the risk of heart disease in women of all ages"

More recently, another NRMI study showed remarkable reductions in hospital mortality after MI during the past decade for both sexes, especially women, possibly in part because of better recognition and management of cardiovascular risk factors in women.